Can flow murmurs kill you?

Answer 1

Asianboy - DO NOT LET THE_SMITH'S ANSWER SCARE YOU! It is not completely accurate and much of what he said is not true! A murmur is not a diagnosis, it is just a word medical people use to describe an extra "whoosh" sound that we hear when we listen to your heart.

The term "flow murmur" is used to describe a "whoosh" sound that is caused by high blood flow through a valve and is generally an INNOCENT FINDING that WILL NOT KILL YOU. This can happen when a person is nervous, when they have a fever, when their blood count is low... but they can also be heard when there is nothing wrong with you. Most murmurs are NOT due to "faulty heart valves" as The_Smith suggests, although abnormal valves can also cause murmurs. Doctors can often tell if a murmur is innocent or pathologic by how loud it is and what it sounds like, and if they are not sure, a test called an echocardiogram can be used to make sure your valves are normal. If you are concerned about your murmur, ask your doctor if he/she thinks it is abnormal!

Also, a murmur does NOT usually increase your risk for blood clots and almost never requires blood thinners. Murmurs ARE caused by turbulent flow, but turbulence does NOT increase the tendency for blood to clot. On the contrary, blood that is sluggish or moving slowly IS more likely to clot.

Remember, people on Yahoo! Answers often have no idea what they are talking about, so if you have concerns, ask your doctor. I hope that helps. Good luck!

In response to
THE_SMITH:

1. That's ridiculous! I found a reference for you. A systolic murmur is present in up to 60 percent of patients, with 90 percent being associated with a normal echocardiogram... innocent midsystolic murmurs.

Does this patient have an abnormal systolic murmur?
Etchells E; Bell C; Robb K
JAMA 1997 Feb 19;277(7):564-71.

Our objective was to review the available evidence of the precision and accuracy of the clinical examination for abnormal systolic murmurs. We conducted a MEDLINE search, manually reviewed all reference lists, and contacted authors of published studies. Each study was independently reviewed by 2 observers and graded for methodologic quality. We found that most studies were conducted using cardiologist examiners. In the clinical setting, the reliability of detecting systolic murmurs was fair (kappa, 0.30-0.48). The most useful findings for ruling in aortic stenosis are a slow rate of rise of the carotid pulse (positive likelihood ratio, 2.8-130), mid to late peak intensity of the murmur (positive likelihood ratio, 8.0-101), and decreased intensity of the second heart sound (positive likelihood ratio, 3.1-50). The most useful finding for ruling out aortic stenosis is the absence of murmur radiation to the right carotid artery (negative likelihood ratio, 0.05-0.10). Smaller, lower-quality studies indicate that cardiologists can accurately rule in and rule out mitral regurgitation, tricuspid regurgitation, hypertrophic cardiomyopathy, and echocardiographic mitral valve prolapse. We conclude that the clinical examination by cardiologists is accurate for detecting various causes of abnormal systolic murmurs. Studies of the clinical examination by noncardiologists are needed.

If you are a physician and you are ordering echos for every murmur you hear, you are ordering TOO MANY ECHOS!

2. I will give you one thing... stenotic AV valves can lead to thrombus formation, but that is because of STASIS not TURBULENCE. What you are talking about are jet lesions which are more likely to become infected than to form clot. You said if the murmur is on the left side, he could develop a clot and stroke out or have an MI. Aortic stenosis - I've only seen this ONCE and that was in someone with a bicuspid valve that had been operated on years ago and had become severely calcified and shaggy looking. It wasn't the turbulence that predisposed to thrombus formation, it was the grossly abnormal valve. Aortic insufficiency - no significant risk of thrombus formation. Mitral regurgitation - some think this might actually DECREASE risk of thrombus formation in patients with atrial fibrillation or flutter. Mitral stenosis - stasis in the LA can lead to atrial thrombus formation, but this is not due to turbulence.

I'm glad to discuss this with you further. I am not trying to put you down; I just want to correct the misinformation you've given this poor guy. Neither am I telling him that everything is fine. Everything probably IS fine, but I always emphasize that a diagnosis can only be made with a history, physical and appropriate testing. Any questions should be addressed to a doctor familiar with his issues. Are you a resident or a med student? You seem to know something about cardiology but you haven't really mastered it yet. Seriously. E-mail me. I'd love to clear things up with you. Our job as physicians is to educate, and as a cardiologist, I wouldn't give advice about leukemia, but I am happy to talk about heart-related issues.

Answer 2

It really depends on how bad the murmur is, but the long and short of it is, yes they can. Murmurs are gushing sounds heard through a stethoscope when listening to the heart; these are cause by turbulent blood moving through faulty heart valves (the same thing occurs in narrowed blood vessels (eg. due to plaques on blood vessel walls), these are called bruits). Most deaths related to murmurs usually involve complete failure of the valve, but the valve needs to be on its last legs and if you had that your doctor wouldn't be sending you home to ask this question. There is another means that murmurs can do you damage and that is via clot formation. When ever blood churns in turbulent fashion, whether in the heart or in you blood vessels, blood clots tend to form. If the murmur is in the left side of your heart and a blood clot forms, the clot can be transported to any part of your body (except the lungs, but that another story) where it can block smaller blood vessels, starving the surrounding tissue of oxygen. If this happens in the blood vessels surrounding the heart you can have a myocardial infarction (heart attack) or if it occurs in the brain you can have a stroke. Having painted a picture of doom and gloom I must say however that your doctor (I'm assuming you learned of your murmur through your GP) would have placed you on blood thinning medication had he/she thought you were in danger of this happening - so don't freak out. If somehow you were diagnosed with a murmur from someone who isn't a doctor, I would strongly suggest you pop into you local family practitioner and get checked out properly - not only do misdiagnoses happens everyday, especially by people who aren't fully qualified to make the diagnosis, but you may also need medication or other treatment. All the best, hope this helps.

savoirfairemn:

I don't even know where to start with your reply to my answer - I don't have a lot of time so I'll only outline the primary problems.

1. Unless you are a child innocent murmurs are uncommon, in an adult it is usually the result of turbulent blood flow through an abnormality, in the heart this is generally the outcome of a, quite often minor, valvular issue. I do however agree that many murmurs are minor and will not kill, this is why I stated that if Asianboy's doctor who diagnosed it (I know it isn't a diagnosis, I'm using it simply as a term to express the discovery of a symptom) didn't make a fuss then it is probably nothing to worry about. However if a friend who is a physio or an exercise physiologist heard it, then it is something worth checking out, because regardless of your 'everything is fine' outlook it could indicate something a little more sinister.

2. Turbulence CAN encourage thrombus formation - this is primarily true in atherosclerotic blood vessels however it can also occur with stenotic heart valves should that be the source of the murmur. You are assuming that turbulent blood only has a low pressure aspect to it - anything that can cause a high pressure area on either side of the defect can result in damage to the vessel/heart walls that in turn can result in a thrombus.

There is one thing that I do agree with you, that is that thinners are rarely given for murmurs. That statement could have been given a little more thought, however it is not incorrect, just not likely.

It is true that I placed a more morbid turn on my answer by stating the worst case scenario, however I don't believe in creating complacency in a person who potentially could have a damaging condition. If it is nothing then great, but if it is something else then I'd prefer to scare someone into a trip to their doctor than lull them into a false sense of security.